Provider Demographics
NPI:1891971198
Name:POPE SHENOUDA LLC
Entity Type:Organization
Organization Name:POPE SHENOUDA LLC
Other - Org Name:1ST CHOICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:201-400-7327
Mailing Address - Street 1:2228 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-4351
Mailing Address - Country:US
Mailing Address - Phone:727-934-1300
Mailing Address - Fax:727-934-1313
Practice Address - Street 1:2228 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-4351
Practice Address - Country:US
Practice Address - Phone:727-934-1300
Practice Address - Fax:727-934-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH232083336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032556200Medicaid
2010664OtherPK